 I am Dr. Bharath K. Kadadi, consultant, hand, wrist and brachial plexus surgeon, practicing in Bengaluru for the last two decades. I am associated with Manipal Hospital in Malaysia for more than a decade now. So hand is functionally one of the most important parts of the body, economically and functionally the most important parts of the body because without hand you just can't do anything in your day to day activities. Imagine a single finger or the part of the hand or wrist is injured, you cannot use it to your day to day activities like brushing your teeth, washing your face or even having your breakfast, it becomes so difficult. So wrist is a complex joint because it has got a polyaxial range of movement in a polyaxial direction. So you have got flexion, that is wrist flexion, wrist extension, ulnar division, radial division and circumduction. Any person in his lifetime moves the wrist for more than 5 to 10 million times so you know how important it is, how stable it is and remember if anybody complains of any pain in the wrist joint becomes extremely difficult to carry out the routine activities. And the common causes for pain in the wrist are mainly it can be classified into the radial sided pain towards the radius that means towards the thumb, the radial sided wrist pain or it could be a central causes of wrist pain that means in the center or it could be the along the little finger the ulnar sided wrist pain that is the common causes, the radial sided, the central causes or the ulnar sided wrist pain. The radial side causes commonly you might have seen people with overuse of the wrist they can develop what you call decreased sinusoidalities, people using the computer for long hours, people doing you know bowling activities, usage of the basically hand not day to day household activities like you know housemaker using her hand frequently for cooking and so many other activities at home. They can develop what you call a decreased sinusoidalities where the extensive tendons to the thumb can get impacted here because of the band and then compression causes pain. That can be excruciating pain, many times it needs rest, injections or you know physiotherapy and if it does not work then we do a released surgical release. Then other causes of pain and numbness in the hand and wrist is basically the carpal tunnel syndrome where there is a compression in the median nerve in the wrist region because of the molar carpal ligament this can be seen in people with hypothyroid or people working with computer for long hours, in people working with vibrator and missionary they have severe pain and numbness in the night, they just cannot sleep. So, when you ask them one simple thing one simple diagnostic aspect is when you ask them doctor cannot sleep because of severe numbness and pain that's the moment you say that you know that this is a median nerve which can be compressed. So, we confirm that by doing a nerve conduction studies which will confirm the compression of the median nerve and then if it is so bad that it does not subside with medicines and physiotherapy then we do a minus surgery called carpal tunnel release surgery where release the band compressing the nerve and the best compliment you get is the patient the next day after surgery the patient tells you doctor I had the most peaceful sleep in so many years. And with going to the next level we also do it what you call endoscopic carpal tunnel endoscopic we so the minimally invasive technique as you all know that other scopy and endoscopy where you put in a needle attached to a camera inside the joint similarly we pass in a scope under the carpal tunnel and then there is an endoscopic knife we just release the band that's called endoscopic carpal tunnel release. So, the other common conditions in the wrist are you can have patients with scaphoid fracture very common you see patients developing fall on the outside hand fall while playing cricket or any sports activity for that matter landing on the it's called fall on the outside hand. So, one of the commonest injuries is at the base of the thumb the trapezius or the scaphoid this latest fractures. So, when you have a scaphoid fracture the most interesting part of this is it get missed out in the initially 1 to 2 months it just gets missed out because many of us think it is sprain or it you be able to do your activity with mild pain and then when the pain comes back 2 to 3 months later then you know you do an X-ray and have a look then the fracture by the time it would already gone for non-union. So, it's very important to address this pain in the wrist immediately so that you do not go in for a do not neglect this condition and go in for a non-union because once it goes for non-union the only treatment for a scaphoid is surgery where you fix this scaphoid with a screw a special screw called a headless compression screw or a Herbert screw and then aim at union because if it does not unite then it can cause trouble the whole wrist the whole wrist can go in for wrist arthritis mid-couple arthritis. The other common condition we see in the wrist is called the lunate avasclinicros of the lunate called the keen box this is seen in young individuals very common in ladies and so many medical students have operated with keen box because this can be because of the repeated stress they are undergoing or it could be because of the ulnar variance many times the wrist and the ulnar should be of equal length but sometimes what happens the wrist is longer than the ulnar the radius is longer than the ulnar it causes pressure over the lunate and they are prone for keen box 670 percent of them have a negative ulnar variance so when these conditions so often it progresses to stage 1 2 3 4 is arthritis so before they go into arthritis we can actually do a minus surgery to re-vascularize the lunate so we level the bone leveling procedures called level the radius in alum by a small osteotomy and plating and then to blood supply is a small thin like a thread no blood vessel goes into the bone with the blood vessel here you pick it up and then place it on the lunate that is called bone grafting with vascularized bone grafting technique so that is called the keen box treatment of keen box and do very well they connect to three to six months time the pain goes away and the lunate can get re-vascularized in six to eight months time and you might have seen people with playing tennis or badminton and having severe wrist pain in the ulnar aspect the ulnar side of the wrist called the ulnar side of the wrist pains very painful because it can also happen even by pulling a heavy trolley bag traveling abroad the heavy you know trolley bags and then we try to pull or even when you're parking your bike you can twist your hand called wrist strain or even when you pull or fall from the sports injuries or even a road traffic accidents so this is called a triangular fibrocartilage complex in the wrist so it takes the shock on the ulnar aspect of the wrist so this is very important so that is the ligament called the meniscus homolog where that can get injured from the bone called ulnar it gets pulled off and they have severe pain you can go on for some time mild sprains you can treat them with splinting and physiotherapy but if the ligament is torn away from the bone we do a MRI and confirm that and then what we do a wrist arthroscopy that's the latest technology we've been using for last few years now where we put in a small 2.5 millimeter needle inside the joint connect it to a camera look at the whole joint you can see the 360 degrees the whole joint in the with the help of the fine arthoscope 2.4 and 1.9 mm arthoscope and then from outside we can pass in a suture hold the pass the suture and then tighten it transfer to you can tighten it to the bone also so they get once they get the ligament is repaired you immobilize for almost 4 to 6 weeks and then physiotherapy for 4 to 6 weeks and then we have patients after TFC repair getting back to their previous level of activity like 20 kilos or 20 to 40 kilos of weightlifting cross-training those kind of activities yes some of the other common conditions in the wrist you see a bump in the wrist it's called a swelling or a bump coming from the wrist many of you when you bend or flex the wrist you can see a bump there and it goes unnoticed for months together and sometimes when it can cause pain when it grows in size or when it impinges in the joint it causes pain it's called a ganglion cyst one of the commonest swelling in the wrist joint is called a ganglion cyst it's a water filled balloon coming all the way from the joint because the capsule is torn it gets expanded like a balloon and then projects in the wrist called a water filled balloon or a ganglion cyst so if it is painful or growing in size we do a minus surgery to excise this ganglion cyst and with this let us technology of arthroscopy we can also do a pass in a arthoscope and then excise it to a arthroscopically there's a we just marginalize the ganglion and then make sure that it doesn't recur and we start immobilizing as early as 2 to 3 weeks after the ganglion excision and there are so many other conditions in the wrist like you know there can be because there are many bones involved even the conditions are also more for example you have a scapulonate dissociation where after an injury you might not have a covered fracture but you can have a ligament injury so injuries can be either bony injuries or a ligament injury when you have a ligament injury the force passing through the two bones called scapulonate so these two bones always move together so once the ligament in between these two is disrupted so the scapulonate flexes and lunate extends so they move in different directions causing a severe pain instability and left alone it can go in for arthritis of the wrist so this has to be addressed early and again they have stages of that 1 2 3 4 depending on the stage we can also do a arthroscopic ligament repair and treat if they come in late stages like stage 4 then we can take a graft passing through these ligaments and then also repeat repair and then mobilize then with a good rehabilitation or a hand physiotherapy the other conditions we see is tumor swelling in the wrist joint like you have a n-condroma coming in the capitate scapulonate or osteocondroma in the scapulonate which can impen the movements affect your deteriorated activity which can be confirmed with an x-ray or maybe you might not have to go in for further investigation like MRI scan have a look and once you know that there is a swelling coming from the particular bone like capitate or a scapulonate or a lunate then you go if it is painful you go into a minus surgery we have cured the bone putting the bone graft and they do pretty well but you have to rule out other conditions like you know the wrist joint like rheumatoid arthritis infective conditions like tuberculosis because people having nonspecific pain and inflammation all over the wrist so when you have a condition like that then you must rule out what you call rheumatoid arthritis in today's world there are millions and millions of patients of rheumatoid arthritis having pain in both the hands both the wrist joints both elbows both shoulders its symmetrical presentation commonly seen between the age of 20 to 50 years ladies is more of commonly affected than men so rheumatoid arthritis is a condition where it needs to be treated with a good medication is called a disease modifying rheumatology drugs or the biological drugs for rheumatoid which can be controlled sometimes when that stage advances to affect the joint or the cartilage then we can do in a arthroscopic cyanobacteria biopsy confirm the disease and then further process and treat it when you go in for a stage the last stage of arthritis we can always put in a freshen up the cartilage and put in a plate and put in the called wrist arthritis wrist arthritis is one of the very good surgical procedures for a very unstable and arthritic wrist so that gives excellent stability for the wrist so it's very important to keep the wrist stable so be immobilized in 10 15 years of extension and then they able to do the day to day activity so that way so wrist being complex joint and even sometimes the redo couple are the initial stages this can impinge and causes pain between the ridden scoffers so we again look in arthroscopically we can trim this bone if this bone is longer we can also arthroscopically trim this bone called wave first procedure this is called riddle stellar ductomy so many procedures which can be done arthroscopically and also by open techniques so the whole idea is to get the wrist back to pain free range of motion number one number two stability that means they should be able to get back to their previous level of activity like you know whatever lifting weight riding bike or even working on the computer and that's our aim is to in the hand and wrist clinic where we aim to a patient make the patient pain free and get back to their previous level of activity by treating the corresponding conditions in the month of august 2 2020 I visited Manipal most of the complaints of pain and numbness of the right hand and accordingly I was asked to consult Dr. Bharat Kadadi who happened to be the orthopedic surgeon who specialized in hand and upper limb surgery accordingly he advised me to undergo a surgical procedure of carpal tunnel release and arthroplasty of the first copper metacarpal joint as it had fourth degree arthritis accordingly the surgery was done in the month of September 2020 and after that the recovery process started I was advised to show my hand of progress of recovery to the orthopedic to the hand surgeon every week practically and which I did very obediently and he also had followed up my case very well and the added value was of the visit to the department of physical medicine and rehabilitation in Manipal Hospital for occupational and physiotherapy as per the instructions of Dr. Bharat Kadadi a few words about this outstanding skilled hand surgeon Dr. Bharat Kadadi to my surprise and pride he discovered me as his teacher way back in the 90s as a student of undergraduate student of my somatic college having met him I was overwhelmed and so did he also and the issue which came out it became very confident much more confident of the very this and seeing him also and as we all know the hand is a very important component of the human body meant for precision grip and being a very highly vascular structure as well as abundant nerve supply and there are nearly about 20 delicate intrusive muscles in the hand as an anatomist I would like to make my own feelings get expressed and and seeing the outcome of the surgery was a big challenge for me but having met Dr. Bharat Kadadi made me forget the possibilities of anything going to happen to me because I was very very sure that he's going to give back my hand to normalcy and really it happens. So after going through this if you have any doubts regarding the complex problems of the wrist you can always post in your questions into the chat box and then we will do our best efforts to explain the causes and the treatment options and if you like it you can share with your colleagues and friends so that you spread the message that this is a complex condition and can be treated with ease.